Preoperative anemia and postoperative thirty-day mortality in patients undergoing non-cardiac surgery: a secondary analysis based on a single-center retrospective study.

2020 ◽  
Author(s):  
Xueying Luo ◽  
Baoer Liu ◽  
Sujing Zheng ◽  
Liping Yang ◽  
Ya Li ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Emergency Surgery ◽  
Secondary Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Effect Sizes ◽  
Severe Anemia ◽  
Patient Demographics ◽  
Mild Anemia ◽  
Singapore General Hospital ◽  
Different Ages

Abstract Introduction There is controversial and limited evidence to clarify the specific relationship between anemia and perioperative mortality in surgical patients at different ages. We aimed to investigate the relationship between them in patients undergoing non-cardiac surgery of different ages. Methods The present study was a retrospective analysis of the electronic medical records of 90,785 patients who underwent general surgery at the Singapore General Hospital from January 1, 2012 to October 31, 2016. We reanalyzed these data including patient demographics, comorbidities, laboratory results, surgical priority and surgical risk. The main outcome measures included anemia and postoperative 30day mortality. Results The average age of the 86,748 participants enrolled was 52.73 ± 17.24 years old, of which approximately 54.05% were female. 62878 (72.48%)people in the study population had no anemia, 13006 (14.99%) had mild anemia, 10863 (12.52%) had moderate to severe anemia. Multivariate logistic regression analysis showed that anemia was independently associated with postoperative 30day mortality [Compared with none anemia, adjusted odds ratio of mild anemia:1.6404, (95% confidence interval [CI]: 1.2295-2.1886; P =0.000768); and adjusted OR of moderate or severe anemia: 2.6643 (95% [CI]: 2.0315- 3.4941) ;P<0.000001)]. There is no statistical difference among the effect sizes of anemia on 30day mortality, regardless of different age(P=0.2469), gender(p=0.8067), and race (0.4629). And the effect sizes of anemia at each stage on postoperative 30day mortality showed statistically significant increase in intra-transfusion, emergency surgery, high surgery risk(p for interaction is 0.0125,0.0001,0.0032,respectively) Discussion In patients undergoing non-cardiac surgery, anemia is an independent risk factor for perioperative 30day mortality, especially among emergency surgery, high-risk surgery and surgery with intraoperative blood transfusion.

scholarly journals Anemia and perioperative mortality in Non-cardiac Surgery patients: a secondary analysis based on a single-center retrospective study

2020 ◽  
Author(s):  
Xueying Luo ◽  
Feng Li ◽  
Haofei Hu ◽  
Baoer Liu ◽  
Sujing Zheng ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Severe Anemia ◽  
Perioperative Mortality ◽  
Icu Admission ◽  
Mild Anemia ◽  
Postoperative Blood Transfusion ◽  
Doubly Robust Estimation ◽  
Anemia Group ◽  
Doubly Robust

Abstract Background : Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in non-cardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results : We identified 85,989 patients, of whom75, 163 had none or mild anemia(Hemoglobin>90g/L) and 10,826 had moderate or severe anemia(Hemoglobin≤90g/L). 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (Odds Ratio, 1.510; 95% Confidence Interval(CI), 1.049 to 2.174) compared with none or mild anemia group (2.47% vs. 1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001).There was no statistical difference in Intensive Care Unit(ICU) admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery.

scholarly journals Anemia and perioperative mortality in Non-cardiac Surgery patients: a secondary analysis based on a single-center retrospective study

2020 ◽  
Author(s):  
Xueying Luo ◽  
Baoer Liu ◽  
Sujing Zheng ◽  
Liping Yang ◽  
Ya Li ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Severe Anemia ◽  
Perioperative Mortality ◽  
Icu Admission ◽  
Mild Anemia ◽  
Postoperative Blood Transfusion ◽  
Doubly Robust Estimation ◽  
Anemia Group ◽  
Doubly Robust

Abstract Introduction: Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in non-cardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results We identified 85,989 patients, of whom75, 163 had none or mild anemia and 10,826 had moderate or severe anemia. 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (odds ratio, 1.510; 95% CI, 1.049 to 2.174) compared with none or mild anemia group (2.47% vs. 1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001).There was no statistical difference in ICU admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery.

scholarly journals The Effect of Supplemental Oxygen on the Incidence of Hypoxaemia after Premedication in Patients Undergoing Cardiac Surgery

1997 ◽  
Vol 25 (4) ◽  
pp. 347-349 ◽  
Author(s):  
C. F. Royse ◽  
R. J. B. Tiernan ◽  
S. M. Portelli ◽  
S. Davies ◽  
R. Arblaster ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Arterial Oxygen Saturation ◽  
Supplemental Oxygen ◽  
Arterial Oxygen ◽  
Patient Demographics ◽  
Routine Administration ◽  
High Incidence ◽  
Patient Groups ◽  
To Receive ◽  
Elective Patients

Opiate premedication may cause significant respiratory depression, particularly when other sedative agents such as scopolamine or benzodiazepines are added. This can cause hypoxaemia with potential for worsening myocardial ischaemia in cardiac surgery patients. The aim of this study was to investigate the incidence of hypoxaemia (SpO2 <90%) in elective patients undergoing cardiac surgery and to assess the efficacy of supplemental oxygen in preventing it. One hundred elective patients without significant respiratory disease or cardiac failure, who received both an opiate and a sedative premedication, were prospectively randomized to receive either oxygen via a facemask at 4 l/min or no oxygen. Continuous arterial oxygen saturation was recorded using a pulse oximeter from the time of premedication until the patient arrived in theatre. An SpO2 <90% was recorded as a significant event and oxygen was administered to the patients. Six patients were excluded because of equipment failure or protocol violations. The patient groups were comparable with respect to patient demographics, premedication type and dose or the duration of monitoring. In patients receiving oxygen (n=48) there were no episodes of hypoxaemia (0%). In patients not receiving oxygen (n=46) there were 14 episodes of hypoxaemia (30%, P<0.0001). We conclude that there is a significantly high incidence of hypoxaemia in cardiac surgery patients following combined opiate and sedative premedication and that it can be reduced by the routine administration of supplemental oxygen.

scholarly journals Prevalence of anemia among pregnant women in rural Koppal: a study from teaching hospital, Koppal, India

2017 ◽  
Vol 6 (9) ◽  
pp. 3792 ◽  
Author(s):  
Seema B. N.
Keyword(s):  
Pregnant Women ◽  
Public Health Problem ◽  
Peripheral Blood Smear ◽  
Poverty Line ◽  
World Health ◽  
Major Public Health Problem ◽  
Severe Anemia ◽  
Mild Anemia ◽  
High Prevalence ◽  
Prevalence Of Anemia

Background: Anemia is the nutritional deficiency disorder and 56% of all women living in developing countries are anaemic according to World Health Organization. India has the highest prevalence of anaemia and 20% of total maternal deaths are due to anemia. To determine the prevalence of anemia and factors influencing its causation among pregnant women.           Methods: This is the study of 1769 pregnant women which was conducted in a rural population of Koppal district, Karnataka, India, from June 2016 to November 2016 i.e. a period of 6 months. This longitudinal prospective observational study was conducted in the district hospital of Koppal. Anemia was classified as per the Indian Council of Medical Research (ICMR) criteria. The diagnosis of anemia was undertaken by peripheral blood smear examination and standard hemoglobin estimation by shale’s method.Results: The average age of pregnant women was 23.5 years, ranging between 18 and 40 years. Most of the women belonged to below poverty line (BPL) families (84.6%) and Hindu religion (98%). Regarding education, 28.9% were illiterates. The mean haemoglobin level was found to be 8.95. Prevalence of anemia was 96.5% among the pregnant females in this region of rural Koppal. Out of these 22.47% had mild anemia, 56.30% had moderate anemia, 14.98% had severe anemia and 2.73% very severe anemia according to ICMR classification of anemia.Conclusions: High prevalence of anemia among pregnant women indicates anemia to be a major public health problem in the rural community and indicates strict implementation of National Nutrition Anemia prophylaxis programme. Factors such as socioeconomic status, education, birth interval, and gravida contribute to this high prevalence.

scholarly journals Opioid-Sparing Cardiac Anesthesia: Secondary Analysis of an Enhanced Recovery Program for Cardiac Surgery

2020 ◽  
Vol 131 (6) ◽  
pp. 1852-1861 ◽  
Author(s):  
Michael C. Grant ◽  
Tetsuro Isada ◽  
Pavel Ruzankin ◽  
Allan Gottschalk ◽  
Glenn Whitman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Enhanced Recovery ◽  
Secondary Analysis ◽  
Cardiac Anesthesia ◽  
Enhanced Recovery Program ◽  
Opioid Sparing ◽  
Recovery Program

scholarly journals Successful Retrieval of Embolized Amplatzer Septal Occluder from Descending Thoracic Aorta: A Surgical Emergency.

2019 ◽  
Vol 15 (1) ◽  
pp. 37-39
Author(s):  
CM Mosabber Rahman ◽  
Md Alauddin ◽  
Satish Vaidya ◽  
Debasish Das ◽  
Arif Ulla Bhuiyan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Thoracic Aorta ◽  
Emergency Surgery ◽  
Amplatzer Septal Occluder ◽  
Descending Thoracic Aorta ◽  
Septal Defects ◽  
Cardiac Centre ◽  
Device Embolization ◽  
Successful Retrieval ◽  
Medical University

Amplatzer septal occluder is widely used by the cardiac interventionists as an effective alternative to traditional surgery for atrial septal defects. However, although rare, device may embolize during or after procedure due to several reasons. We report a case of device embolization into the descending thoracic aorta during percutaneous closure of ASD in a 14-year-old girl which was successfully retrieved by emergency surgery at Department of Cardiac Surgery, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Bangladesh. University Heart Journal Vol. 15, No. 1, Jan 2019; 37-39

Fetal breathing, sleep state, and cardiovascular responses to graded anemia in sheep

1987 ◽  
Vol 63 (4) ◽  
pp. 1463-1468 ◽  
Author(s):  
B. J. Koos ◽  
H. Sameshima ◽  
G. G. Power
Keyword(s):  
Eye Movements ◽  
Cardiovascular Responses ◽  
Severe Anemia ◽  
Sleep State ◽  
Fetal Sheep ◽  
Rapid Eye Movements ◽  
Mild Anemia ◽  
Arterial Blood ◽  
Moderate Anemia ◽  
Pressure Changes

Graded anemia was produced for 2 h in 10 unanesthetized fetal sheep by infusing plasma in exchange for fetal blood. This reduced the mean fetal hematocrits during the 1st h of anemia to 19.7 +/- 0.5% [control (C) = 28.2 +/- 1.1%] for mild anemia, 17.4 +/- 0.9% (C = 30.0 +/- 1.1%) for moderate anemia, and 15.1 +/- 1.0% (C = 29.2 +/- 1.3%) for severe anemia. The respective mean arterial O2 contents (CaO2) were 4.46 +/- 0.20, 3.89 +/- 0.24, and 3.22 +/- 0.19 ml/dl. Mean arterial PO2 was reduced significantly (by 2 Torr) only during moderate anemia, and mean arterial pH was decreased only during severe anemia. No significant changes occurred in arterial PCO2. Fetal tachycardia occurred during anemia. Mean arterial pressure was reduced by 2–3 mmHg during mild anemia; however, no significant blood pressure changes were observed for moderate or severe anemia. The incidence of rapid-eye movements and breathing activity was not affected by mild anemia, but the incidence of both was reduced significantly during moderate and severe anemia. It is concluded that 1) a reduction in CaO2 of greater than 2.48 +/- 0.22 ml/dl by hemodilution inhibits rapid-eye movements and breathing activity, and 2) the PO2 signal for inhibition does not come from arterial blood but from lower PO2 in tissue.

scholarly journals OPRM1 and COMT polymorphisms: implications on postoperative acute, chronic and experimental pain after cardiac surgery

2020 ◽  
Vol 21 (3) ◽  
pp. 181-193 ◽  
Author(s):  
Maja Matic ◽  
Sjoerd de Hoogd ◽  
Saskia N de Wildt ◽  
Dick Tibboel ◽  
Catherijne AJ Knibbe ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pain Sensitivity ◽  
Secondary Analysis ◽  
Experimental Pain ◽  
Thermal Pain ◽  
Pain Outcomes ◽  
Average Pain ◽  
Postoperative Morphine ◽  
Adult Cardiac Surgery

Aim: Investigate the potential role of OPRM1 (mu-opioid receptor) and COMT (catechol-O-methyltransferase enzyme) polymorphisms in postoperative acute, chronic and experimental thermal pain. Methods: A secondary analysis of 125 adult cardiac surgery patients that were randomized between fentanyl and remifentanil during surgery and genotyped. Results: Patients in the fentanyl group with the COMT high-pain sensitivity haplotype required less postoperative morphine compared with the average-pain sensitivity haplotype (19.4 [16.5; 23.0] vs 34.6 [26.2; 41.4]; p = 0.00768), but not to the low-pain sensitivity group (30.1 [19.1; 37.7]; p = 0.13). No association was found between COMT haplotype and other pain outcomes or OPRM1 polymorphisms and the different pain modalities. Conclusion: COMT haplotype appears to explain part of the variability in acute postoperative pain in adult cardiac surgery patients.

scholarly journals The Risk of Sexually Transmitted Infection and Its Influence on Condom Use among Pregnant Women in the Kintampo North Municipality of Ghana

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Martha Ali Abdulai ◽  
Frank Baiden ◽  
Samuel Afari-Asiedu ◽  
Lawrence Gyabaa-Febir ◽  
Kwame Kesse Adjei ◽  
...  
Keyword(s):  
High Risk ◽  
Condom Use ◽  
Pregnant Women ◽  
Sexually Transmitted Infection ◽  
Secondary Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Cross Sectional Survey ◽  
Transmitted Infection ◽  
Cross Sectional ◽  
Sexually Transmitted

Sexually transmitted infection (STI) affects the reproductive health of both men and women worldwide. Condoms are important part of the available preventive strategies for STI control. The lack of proper risk-perception continues to impede women’s ability to negotiate condom use with their partners. This paper is the outcome of secondary analysis of data collected in a cross-sectional survey that explored the perception of risk of STI and its influence on condom use among 504 pregnant women attending antenatal clinic at two health facilities in the Kintampo North Municipality. Consecutively, three Focus Group Discussions were conducted among 22 pregnant women which was analyzed using thematic analysis technique. Multivariate logistic regression analysis was used to identify possible predictors of condom use and risk of STI. Respondents mean age was 26.0±5.9 years. 47% of respondents self-identified themselves as high risk for contracting STI, 50% of whom were married. High risk status (OR = 2.1, 95% CI: 1.1–4.4), ability to ask for condoms during sex (OR = 0.3, 95% CI: 0.1–0.73), and partner’s approval of condom use (OR = 0.2, 95% CI: 0.01–0.05) were independent predictors of condom use. Condom use (OR 2.9 (1.5–5.7); p=0.001) and marital status (engaged, OR 2.6 (1.5–4.5); p=0.001) were independent predictors of risk of STI. Women who self-identified themselves as high risk for STI successfully negotiated condom use with their partners. This is however influenced by partner’s approval and ability to convince partner to use condoms. Self-assessment of STI risk by women and the cooperation of male partners remain critical.

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